Wiki Multiple Delivery Question

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mkemak

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Good afternoon,
I have never come across this situation before. I have a patient who delivered twice within a year and the insurance company is denying our second delivery as inclusive to another procedure. I've called and talked to two representatives that state it is denying against the original delivery and the second delivery needs to be billed differently. Patient delivered 1/3/22 and again on 11/14/22. I've tried different modifiers and sent the documentation regarding the delivery and I'm still getting denied. Does anybody have any advice to try and get reimbursed for the delivery? Should I be just trying to bill for the antepartum & postpartum care at this point? I feel like I've exhausted all efforts trying to get the delivery claim paid. Any help or advice would be greatly appreciated! TIA!!
 
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mkemak said:
Good afternoon,
I have never come across this situation before. I have a patient who delivered twice within a year and the insurance company is denying our second delivery as inclusive to another procedure. I've called and talked to two representatives that state it is denying against the original delivery and the second delivery needs to be billed differently. Patient delivered 1/3/22 and again on 11/14/22. I've tried different modifiers and sent the documentation regarding the delivery and I'm still getting denied. Does anybody have any advice to try and get reimbursed for the delivery? Should I be just trying to bill for the antepartum & postpartum care at this point? I feel like I've exhausted all efforts trying to get the delivery claim paid. Any help or advice would be greatly appreciated! TIA!!
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You need to get your physician involved in contacting the medical director of the plan. Clearly the dates of service are different and unless this patient has a policy that specifically states only 1 delivery can be paid for per calendar year, they are being obstructive. You might also want to contact your state's Insurance Commissioner on behalf of the patient. Coding cannot fix this issue.
 
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